Recommended Reading

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I'm not certain what happened to the other thread in this topic devoted to recommended reading. While I have noticed that even the most mundane of other topics have an abundance of archived discussions, there seems to be only one page alloted for the exploration and discussion of psychosis and schizophrenia.

No matter. I'm certain we can make do with what we have.

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<img align="right" src=http://pic50.picturetrail.com/VOL438/8397669/15643275/238251734.jpg> <font size=4>Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia</font>
John Read, Loren Mosher and Richard P. Bentall

In the opening chapter of Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia, my co-editors (Richard Bentall and Loren Mosher) and I make our intentions quite clear. We argue that the heightened sensitivity, unusual experiences, distress, despair, confusion and disorganisation that are currently labelled ‘schizophrenic’ are not symptoms of a medical illness. The notion that ‘mental illness is an illness like any other’, promulgated by biological psychiatry and the pharmaceutical industry, is not supported by research and is extremely damaging to those with this most stigmatising of psychiatric labels. It is responsible for unwarranted and destructive pessimism about the chances of ‘recovery’, and has ignored – or even actively discouraged discussion of – what is actually going on in these people’s lives, in their families, and in the societies in which they live.

Models of Madness brings together the body of evidence that will increase the confidence of the majority when faced with that misguided but powerful minority who proclaim with all the trappings of scientific and professional expertness: ‘It’s an illness– so you must take the drugs’, by force if necessary. I say ‘the majority’ because numerous international surveys show that the public (like most mental health professionals and their clients), when asked what causes schizophrenia, cite social factors such as poverty and trauma.

... It is understandable that so many psychologists have accepted the so-called bio-psycho-social model. It allows psychologists interested in schizophrenia to study which psychosocial factors trigger the supposed genetic predisposition, as long as they are prepared to ignore the absence of reliability or validity for the construct they are studying (Bentall, 2003). It permits clinical psychologists to help ‘schizophrenics’ manage their symptoms and prevent relapses by encouraging families to lower their ‘expressed emotion’ (an odd euphemism for hostility and criticism). Anyway, why bother with the tedious old nature–nurture battle now we know everything is an interaction of the two?

Nevertheless, the supposed integration of perspectives implied by the term ‘bio-psycho-social’ model since the 1970s is more illusion than reality. An integral part of this has been the ‘vulnerability-stress’idea that acknowledges a role for social stressors but only in those who already have a supposed genetic predisposition. Life events have been relegated to the role of ‘triggers’ of an underlying genetic time-bomb. This is not an integration of models, it is a colonisation of the psychological and social by the biological. The colonisation has involved the ignoring, or vilification, of research showing the role of contextual factors such as neglect, trauma (inside and beyond the family), poverty, racism,sexism, etc. in the etiology of madness. The colonisation even went so far as to invent the euphemism ‘psycho-education’for programmes promulgating the illness ideology to individuals and families. I admit to a barely suppressed ‘Yes!’ when I read Sharfstein’s comment, ‘We must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model’. So perhaps things really are changing.

On a good day I can see plenty of evidence. The international consumer/survivor movement is alive and well (Chamberlin,2004). British cognitive psychologists are leading a renaissance of the involvement of psychologists in the psychosis field, an area we largely abandoned after the introduction of antipsychotic drugs in the 1950s. They are demonstrating not only that hallucinations and delusions are perfectly understandable in terms of normal psychological processes (e.g. Garety et al.,2001) but also that cognitive therapy is effective for psychosis (e.g. Kingdon & Turkington, 2005) – with or without medication (Morrison et al., 2004). Several other psychological approaches have also been proven effective (Martindale et al.,2000; Read et al., 2004).

Researchers around the world are less afraid to study psychosocial factors, including the near taboo subject of family dysfunction (Read, Seymour & Mosher,2004) as causal agents in the etiology of psychosis, rather than as mere triggers or exacerbators of an imaginary or, at best, grossly exaggerated genetic predisposition( Joseph, 2003). Poverty (Read, 2004),urban living (van Os et al., 2001), racism (Karlsen & Nazroo, 2002), other forms of discrimination (Janssen et al., 2003), child abuse (e.g. Read et al., 2003; Read et al.,in press) and having a battered mother (Whitfield et al., 2005) have all been shown to be highly predictive of psychosis. Some even dare to speak of schizophrenia as being preventable via universal programmes enhancing children’s safety and quality of life (Davies & Burdett, 2004).

There are other positive signs. I have spoken to full houses at the first two British conferences on trauma and psychosis, our book has received positive reviews in psychiatric journals, and the International Society for the Psychological Treatments of the Schizophrenias and other Psychoses (www.isps.org) has grown enormously. The true measure of progress, however, is on the front line of practice. The emerging pockets of excellence across the UK must be brought to the attention of managers still harbouring the industry-sponsored notion that drugs are always the first-choice treatment. The simple truths are that human misery is largely inflicted by other people and that the solutions are best based on human – rather than chemical or electrical – interventions. If mental health service users were involved in negotiating the final truce in the ‘schizophrenia wars’, the bio-bio-bio model would be history. People like choices.

Excerpt Source: <a href=http://www.bps.org.uk/publications/thepsychologist/search-the-psychologist-online.cfm?fuseaction=inc_getFile&ID=928&Publication_ID=1>The bio-bio-bio Model of Madness</a>

See also: The Talking Cure: Book Review